A Review and Expert Opinion on the Neuropsychiatric Assessment of Motor Functional Neurological Disorders.

Perez, David L; Aybek, Selma; Popkirov, Stoyan; Kozlowska, Kasia; Stephen, Christopher D; Anderson, Jordan; Shura, Robert; Ducharme, Simon; Carson, Alan; Hallett, Mark; Nicholson, Timothy R; Stone, Jon; LaFrance, W Curt; Voon, Valerie (2021). A Review and Expert Opinion on the Neuropsychiatric Assessment of Motor Functional Neurological Disorders. The journal of neuropsychiatry and clinical neurosciences, 33(1), pp. 14-26. American Psychiatric Association 10.1176/appi.neuropsych.19120357

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Functional neurological (conversion) disorder (FND) is a prevalent and disabling condition at the intersection of neurology and psychiatry. Advances have been made in elucidating an emerging pathophysiology for motor FND, as well as in identifying evidenced-based physiotherapy and psychotherapy treatments. Despite these gains, important elements of the initial neuropsychiatric assessment of functional movement disorders (FND-movt) and functional limb weakness/paresis (FND-par) have yet to be established. This is an important gap from both diagnostic and treatment planning perspectives. In this article, the authors performed a narrative review to characterize clinically relevant variables across FND-movt and FND-par cohorts, including time course and symptom evolution, precipitating factors, medical and family histories, psychiatric comorbidities, psychosocial factors, physical examination signs, and adjunctive diagnostic tests. Thereafter, the authors propose a preliminary set of clinical content that should be assessed during early-phase patient encounters, in addition to identifying physical signs informing diagnosis and potential use of adjunctive tests for challenging cases. Although clinical history should not be used to make a FND diagnosis, characteristics such as acute onset, precipitating events (e.g., injury and surgery), and a waxing and waning course (including spontaneous remissions) are commonly reported. Active psychiatric symptoms (e.g., depression and anxiety) and ongoing psychosocial stressors also warrant evaluation. Positive physical examination signs (e.g., Hoover's sign and tremor entrainment) are key findings, as one of the DSM-5 diagnostic criteria. The neuropsychiatric assessment proposed emphasizes diagnosing FND by using "rule-in" physical signs while also considering psychiatric and psychosocial factors to aid in the development of a patient-centered treatment plan.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Aybek, Selma

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1545-7222

Publisher:

American Psychiatric Association

Language:

English

Submitter:

Chantal Kottler

Date Deposited:

13 Nov 2020 12:00

Last Modified:

23 Jan 2021 01:32

Publisher DOI:

10.1176/appi.neuropsych.19120357

PubMed ID:

32778007

Uncontrolled Keywords:

Conversion Disorder Functional Limb Weakness Functional Movement Disorder Psychogenic

BORIS DOI:

10.7892/boris.147391

URI:

https://boris.unibe.ch/id/eprint/147391

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